Podcast
Questions and Answers
How does a society's culture primarily influence the definition of mental health and mental illness?
How does a society's culture primarily influence the definition of mental health and mental illness?
- By controlling access to mental health resources and treatments.
- By establishing universal medical standards for diagnosis.
- By enforcing legal definitions of mental capacity and responsibility.
- By shaping values and beliefs, which then affect perceptions of acceptable behavior. (correct)
Which of the following best illustrates the concept of mental health as defined by the World Health Organization?
Which of the following best illustrates the concept of mental health as defined by the World Health Organization?
- Maintaining stable employment and financial independence.
- The ability to perform daily tasks without assistance.
- A state of complete physical, mental, and social well-being. (correct)
- Absence of diagnosed psychological disorders.
A person who demonstrates effective coping skills, positive interpersonal relationships, and emotional stability is MOST likely exhibiting characteristics of:
A person who demonstrates effective coping skills, positive interpersonal relationships, and emotional stability is MOST likely exhibiting characteristics of:
- High intelligence.
- Financial security.
- Optimal mental health. (correct)
- Strong physical fitness.
Which of the following is an example of an interpersonal factor that influences mental health?
Which of the following is an example of an interpersonal factor that influences mental health?
A community that promotes diversity, offers access to resources, and has a low tolerance for violence is MOST directly supporting which aspect of mental health?
A community that promotes diversity, offers access to resources, and has a low tolerance for violence is MOST directly supporting which aspect of mental health?
An individual's capacity for growth, emotional resilience, and self-esteem are categorized as what type of factors influencing mental health?
An individual's capacity for growth, emotional resilience, and self-esteem are categorized as what type of factors influencing mental health?
If a person struggles with intimacy and maintaining a balance between separateness and connectedness in relationships, which area of mental health is MOST directly affected?
If a person struggles with intimacy and maintaining a balance between separateness and connectedness in relationships, which area of mental health is MOST directly affected?
Which scenario BEST demonstrates the dynamic nature of mental health?
Which scenario BEST demonstrates the dynamic nature of mental health?
A client repeatedly asks a student nurse for a date outside of the clinical setting. What is the MOST appropriate initial action for the student nurse to take?
A client repeatedly asks a student nurse for a date outside of the clinical setting. What is the MOST appropriate initial action for the student nurse to take?
A student nurse is concerned about potential violence from clients with serious mental illness, based on media portrayals. What information would be MOST accurate and reassuring for the student?
A student nurse is concerned about potential violence from clients with serious mental illness, based on media portrayals. What information would be MOST accurate and reassuring for the student?
A student nurse recognizes a close family friend as a patient on the psychiatric unit. What is the MOST appropriate course of action for the student?
A student nurse recognizes a close family friend as a patient on the psychiatric unit. What is the MOST appropriate course of action for the student?
A student nurse discovers they share similar life experiences to a client. What is the MOST appropriate way to manage this realization?
A student nurse discovers they share similar life experiences to a client. What is the MOST appropriate way to manage this realization?
Which statement BEST describes the primary goal of the Alameda Model in addressing psychiatric emergencies?
Which statement BEST describes the primary goal of the Alameda Model in addressing psychiatric emergencies?
According to the Alameda Model, what percentage of patients presenting to a general ED for psychiatric emergencies required hospitalization?
According to the Alameda Model, what percentage of patients presenting to a general ED for psychiatric emergencies required hospitalization?
What outcome was MOST significantly improved by the implementation of the Alameda Model?
What outcome was MOST significantly improved by the implementation of the Alameda Model?
A student nurse observes a client becoming increasingly agitated and displaying signs of potential aggression. What is the MOST appropriate immediate action for the student to take?
A student nurse observes a client becoming increasingly agitated and displaying signs of potential aggression. What is the MOST appropriate immediate action for the student to take?
While interacting with a client, a student nurse feels triggered by the client's description of past trauma, which mirrors the student's own experiences. What is the BEST course of action for the student?
While interacting with a client, a student nurse feels triggered by the client's description of past trauma, which mirrors the student's own experiences. What is the BEST course of action for the student?
A client makes a disparaging remark about mental health treatment and expresses concern about the stigma associated with being on the psychiatric unit. What is the MOST appropriate response by the student nurse?
A client makes a disparaging remark about mental health treatment and expresses concern about the stigma associated with being on the psychiatric unit. What is the MOST appropriate response by the student nurse?
What was the primary goal of the asylum movement initiated by individuals like Philippe Pinel and William Tuke?
What was the primary goal of the asylum movement initiated by individuals like Philippe Pinel and William Tuke?
Dorothea Dix advocated for which of the following provisions for individuals with mental illness?
Dorothea Dix advocated for which of the following provisions for individuals with mental illness?
What characterized the decline of state hospitals after the initial period of enlightenment?
What characterized the decline of state hospitals after the initial period of enlightenment?
How did Emil Kraepelin contribute to the scientific study of mental disorders?
How did Emil Kraepelin contribute to the scientific study of mental disorders?
Which factor poses a challenge to nurses in providing sensitive and competent care in the United States?
Which factor poses a challenge to nurses in providing sensitive and competent care in the United States?
What was the significance of the introduction of psychotropic drugs in the 1950s?
What was the significance of the introduction of psychotropic drugs in the 1950s?
What was the main goal of the Community Mental Health Centers Act of 1963?
What was the main goal of the Community Mental Health Centers Act of 1963?
What was Linda Richards' primary contribution to psychiatric care?
What was Linda Richards' primary contribution to psychiatric care?
What is deinstitutionalization?
What is deinstitutionalization?
What was the primary focus of nursing care for persons with mental illness in 1882 at McLean Hospital?
What was the primary focus of nursing care for persons with mental illness in 1882 at McLean Hospital?
What crucial element did Hildegard Peplau emphasize that forms the foundation of psychiatric nursing practice today?
What crucial element did Hildegard Peplau emphasize that forms the foundation of psychiatric nursing practice today?
How did SSI and SSDI programs affect individuals with severe and persistent mental illness?
How did SSI and SSDI programs affect individuals with severe and persistent mental illness?
How did June Mellow describe her approach to nursing therapy?
How did June Mellow describe her approach to nursing therapy?
How did changes in commitment laws in the early 1970s impact state hospital populations?
How did changes in commitment laws in the early 1970s impact state hospital populations?
What is the approximate percentage of adults in the U.S. that experience mental illness but do not receive treatment?
What is the approximate percentage of adults in the U.S. that experience mental illness but do not receive treatment?
What role do the American Nurses Association's (ANA) standards of care play in legal settings?
What role do the American Nurses Association's (ANA) standards of care play in legal settings?
Which age group has the highest prevalence of mental illness and the lowest percentage of people receiving treatment?
Which age group has the highest prevalence of mental illness and the lowest percentage of people receiving treatment?
What is the significance of the American Psychiatric Nurses Association (APNA) standards of practice?
What is the significance of the American Psychiatric Nurses Association (APNA) standards of practice?
How did the Mental Health Parity Act of 1996 aim to improve mental healthcare coverage?
How did the Mental Health Parity Act of 1996 aim to improve mental healthcare coverage?
What negative impact is associated with deinstitutionalization?
What negative impact is associated with deinstitutionalization?
What is a key limitation of the Mental Health Parity Act of 1996?
What is a key limitation of the Mental Health Parity Act of 1996?
How does the economic burden of mental illness in the United States compare to that of other diseases?
How does the economic burden of mental illness in the United States compare to that of other diseases?
What percentage of adults and children/adolescents in need of mental health services actually receive the care they need?
What percentage of adults and children/adolescents in need of mental health services actually receive the care they need?
What is the current status of mental health parity laws across different states in the U.S.?
What is the current status of mental health parity laws across different states in the U.S.?
How do cultural differences impact mental health treatment?
How do cultural differences impact mental health treatment?
What is the estimated number of children younger than 7 years old that grow up in homes where at least one parent suffers from significant mental illness or substance abuse?
What is the estimated number of children younger than 7 years old that grow up in homes where at least one parent suffers from significant mental illness or substance abuse?
Which demographic trend in the U.S. poses a challenge for nurses in providing sensitive and competent care?
Which demographic trend in the U.S. poses a challenge for nurses in providing sensitive and competent care?
What was the main focus of early training programs for psychiatric nurses?
What was the main focus of early training programs for psychiatric nurses?
What characterized the evolution of the psychiatric nurse's role with the development of somatic therapies?
What characterized the evolution of the psychiatric nurse's role with the development of somatic therapies?
Which group is paradoxically least likely to receive mental health treatment, according to the text?
Which group is paradoxically least likely to receive mental health treatment, according to the text?
What is the purpose of the 'phenomena of concern' as defined by the American Psychiatric Nurses Association (APNA)?
What is the purpose of the 'phenomena of concern' as defined by the American Psychiatric Nurses Association (APNA)?
According to the Treatment Advocacy Center, which of the following is a potential consequence of nontreatment of mental illness?
According to the Treatment Advocacy Center, which of the following is a potential consequence of nontreatment of mental illness?
Community support service programs aim to address which of the following needs for individuals with mental illness?
Community support service programs aim to address which of the following needs for individuals with mental illness?
What is a primary factor contributing to the variability in availability and quality of community support services across different areas?
What is a primary factor contributing to the variability in availability and quality of community support services across different areas?
Why can teaching independent living skills to some clients with severe mental illness be particularly challenging?
Why can teaching independent living skills to some clients with severe mental illness be particularly challenging?
Despite its flaws, what is an advantage of community-based mental health programs compared to institutionalization?
Despite its flaws, what is an advantage of community-based mental health programs compared to institutionalization?
What is the primary goal of managed care in the context of healthcare?
What is the primary goal of managed care in the context of healthcare?
How do utilization review firms or managed care organizations attempt to control insurance expenditure?
How do utilization review firms or managed care organizations attempt to control insurance expenditure?
What is the intended purpose of case management in mental health care?
What is the intended purpose of case management in mental health care?
Why is psychiatric care particularly susceptible to cost concerns within managed care systems?
Why is psychiatric care particularly susceptible to cost concerns within managed care systems?
What often happens when private insurance limits for mental health care are exhausted?
What often happens when private insurance limits for mental health care are exhausted?
Which of the following is an example of a basic-level function in psychiatric-mental health nursing?
Which of the following is an example of a basic-level function in psychiatric-mental health nursing?
A psychiatric-mental health nurse is working with a client who has difficulty maintaining stable housing and employment. Which 'phenomena of concern' does this MOST directly relate too?
A psychiatric-mental health nurse is working with a client who has difficulty maintaining stable housing and employment. Which 'phenomena of concern' does this MOST directly relate too?
What is a key challenge in providing mental health care in the future?
What is a key challenge in providing mental health care in the future?
Which of the following reflects a psychiatric-mental health nursing 'phenomenon of concern' related to physical and psychological interaction?
Which of the following reflects a psychiatric-mental health nursing 'phenomenon of concern' related to physical and psychological interaction?
Which populations are covered by Medicare?
Which populations are covered by Medicare?
What is the MOST important initial action for a student nurse to take when a client exhibits bizarre or inappropriate behavior?
What is the MOST important initial action for a student nurse to take when a client exhibits bizarre or inappropriate behavior?
How do Medicaid programs generally vary across different states?
How do Medicaid programs generally vary across different states?
A client shares a deeply personal and distressing experience with a student nurse. What should the student nurse do FIRST?
A client shares a deeply personal and distressing experience with a student nurse. What should the student nurse do FIRST?
What is the general eligibility criteria for Medicaid in terms of receiving SSI or SSDI?
What is the general eligibility criteria for Medicaid in terms of receiving SSI or SSDI?
A student nurse is concerned about asking clients personal questions. What understanding should the student nurse integrate into their practice?
A student nurse is concerned about asking clients personal questions. What understanding should the student nurse integrate into their practice?
An advanced practice registered nurse (APRN) in a psychiatric setting is tasked with improving the efficiency of a treatment program. Which action would be MOST aligned with their role?
An advanced practice registered nurse (APRN) in a psychiatric setting is tasked with improving the efficiency of a treatment program. Which action would be MOST aligned with their role?
Which of the following interventions exemplifies milieu therapy?
Which of the following interventions exemplifies milieu therapy?
How can a student nurse BEST address the common concern of saying the wrong thing to a client?
How can a student nurse BEST address the common concern of saying the wrong thing to a client?
A nurse is working with a client experiencing significant self-concept and body image changes following a disfiguring surgery. Which of the psychiatric–mental health nursing phenomena of concern is MOST applicable?
A nurse is working with a client experiencing significant self-concept and body image changes following a disfiguring surgery. Which of the psychiatric–mental health nursing phenomena of concern is MOST applicable?
Which of the following is an example of an advanced-level function for a psychiatric-mental health nurse?
Which of the following is an example of an advanced-level function for a psychiatric-mental health nurse?
A client is struggling with alcohol dependence, hindering their treatment efficacy and overall recovery. Which phenomenon of concern does this MOST directly relate to?
A client is struggling with alcohol dependence, hindering their treatment efficacy and overall recovery. Which phenomenon of concern does this MOST directly relate to?
A nurse is planning interventions for a client experiencing emotional stress related to a recent cancer diagnosis. Which of the following interventions would be MOST appropriate?
A nurse is planning interventions for a client experiencing emotional stress related to a recent cancer diagnosis. Which of the following interventions would be MOST appropriate?
A hospital is located in an area with high rates of violence and poverty. How should the mental health staff consider these factors when treating patients?
A hospital is located in an area with high rates of violence and poverty. How should the mental health staff consider these factors when treating patients?
Which factor most significantly contributes to the frustration experienced by healthcare personnel in emergency departments (ED) dealing with acutely disturbed persons?
Which factor most significantly contributes to the frustration experienced by healthcare personnel in emergency departments (ED) dealing with acutely disturbed persons?
Which situation exemplifies the psychiatric-mental health nursing phenomena related to environmental circumstances?
Which situation exemplifies the psychiatric-mental health nursing phenomena related to environmental circumstances?
What is the primary reason that shorter, unplanned hospital stays contribute to the 'revolving door' phenomenon in mental health care?
What is the primary reason that shorter, unplanned hospital stays contribute to the 'revolving door' phenomenon in mental health care?
How does substance abuse most directly contribute to the 'revolving door' phenomenon among individuals with severe mental illness?
How does substance abuse most directly contribute to the 'revolving door' phenomenon among individuals with severe mental illness?
What is the estimated percentage of the homeless population that is considered chronically homeless and also suffers from either a psychiatric illness or a substance abuse disorder?
What is the estimated percentage of the homeless population that is considered chronically homeless and also suffers from either a psychiatric illness or a substance abuse disorder?
According to the information provided, what is a primary systemic issue contributing to the problems faced by both the homeless mentally ill and those experiencing the revolving door of psychiatric care?
According to the information provided, what is a primary systemic issue contributing to the problems faced by both the homeless mentally ill and those experiencing the revolving door of psychiatric care?
Why is it important that community mental health services are individualized and culturally relevant?
Why is it important that community mental health services are individualized and culturally relevant?
A key objective of the Healthy People initiatives is to address disparities in mental health care. Which population is specifically targeted for increased service provision?
A key objective of the Healthy People initiatives is to address disparities in mental health care. Which population is specifically targeted for increased service provision?
What was a significant consequence of deinstitutionalization that hindered the development of effective community-based care for individuals with severe mental illness?
What was a significant consequence of deinstitutionalization that hindered the development of effective community-based care for individuals with severe mental illness?
According to the Treatment Advocacy Center, what proportion of individuals with severe mental illness have not received any treatment in the past year?
According to the Treatment Advocacy Center, what proportion of individuals with severe mental illness have not received any treatment in the past year?
Which of the following Healthy People 2020 objectives directly addresses the needs of individuals experiencing co-occurring mental health and substance use disorders?
Which of the following Healthy People 2020 objectives directly addresses the needs of individuals experiencing co-occurring mental health and substance use disorders?
What is the most likely outcome of boarding acutely disturbed patients in the emergency department?
What is the most likely outcome of boarding acutely disturbed patients in the emergency department?
Considering the information provided, what is the most effective way to address the problem of frequent rehospitalization among individuals with severe and persistent mental illness?
Considering the information provided, what is the most effective way to address the problem of frequent rehospitalization among individuals with severe and persistent mental illness?
What is the relationship between homelessness and mental illness, based on the information provided?
What is the relationship between homelessness and mental illness, based on the information provided?
If a state decides to reallocate funds from inpatient psychiatric care, where should the funds be directed to have the greatest impact on the mental health of the community?
If a state decides to reallocate funds from inpatient psychiatric care, where should the funds be directed to have the greatest impact on the mental health of the community?
What is the primary aim of the Healthy People initiatives related to mental health?
What is the primary aim of the Healthy People initiatives related to mental health?
Which of the following is an example of an interpersonal factor that can contribute to mental illness?
Which of the following is an example of an interpersonal factor that can contribute to mental illness?
A client expresses feelings of hopelessness, dissatisfaction with relationships, and difficulty coping with daily life. According to the information, these symptoms are MOST indicative of:
A client expresses feelings of hopelessness, dissatisfaction with relationships, and difficulty coping with daily life. According to the information, these symptoms are MOST indicative of:
Which statement BEST describes the primary purpose of the DSM-5?
Which statement BEST describes the primary purpose of the DSM-5?
A patient is diagnosed with a mental disorder, and the clinician uses the DSM-5 to identify relevant psychosocial stressors. Which of the following areas would the clinician MOST likely consider?
A patient is diagnosed with a mental disorder, and the clinician uses the DSM-5 to identify relevant psychosocial stressors. Which of the following areas would the clinician MOST likely consider?
In ancient times, mental illness was often attributed to supernatural causes. How were individuals displaying behaviors associated with mental illness treated?
In ancient times, mental illness was often attributed to supernatural causes. How were individuals displaying behaviors associated with mental illness treated?
Aristotle proposed that imbalances in bodily humors could cause mental disorders. Which treatment aligns with Aristotle's theory?
Aristotle proposed that imbalances in bodily humors could cause mental disorders. Which treatment aligns with Aristotle's theory?
During the early Christian period, how was mental illness typically explained and addressed?
During the early Christian period, how was mental illness typically explained and addressed?
What was the significance of the Hospital of St. Mary of Bethlehem during the Renaissance?
What was the significance of the Hospital of St. Mary of Bethlehem during the Renaissance?
In the context of mental illness, what distinguishes individual factors from social/cultural factors?
In the context of mental illness, what distinguishes individual factors from social/cultural factors?
Which scenario BEST illustrates the influence of a social/cultural factor on mental health?
Which scenario BEST illustrates the influence of a social/cultural factor on mental health?
A health care professional is evaluating a patient who has a history of violent behavior. What consideration should be made when determining if this behavior is indicative of a mental illness?
A health care professional is evaluating a patient who has a history of violent behavior. What consideration should be made when determining if this behavior is indicative of a mental illness?
A clinician is using the DSM-5 to diagnose a patient. What is the MOST important step in this process?
A clinician is using the DSM-5 to diagnose a patient. What is the MOST important step in this process?
How did the Renaissance period in England differentiate the treatment of the mentally ill from criminals?
How did the Renaissance period in England differentiate the treatment of the mentally ill from criminals?
During witch hunts in the colonies (later the United States), how were individuals with mental illness often perceived and treated?
During witch hunts in the colonies (later the United States), how were individuals with mental illness often perceived and treated?
What characterized the period of enlightenment in the 1790s regarding the treatment of persons with mental illness?
What characterized the period of enlightenment in the 1790s regarding the treatment of persons with mental illness?
Flashcards
Mental Health (General)
Mental Health (General)
Ability to fulfill roles, exhibit appropriate behavior.
Cultural Influence on Mental Health
Cultural Influence on Mental Health
Varies across societies; influenced by values and beliefs.
WHO Definition of Health
WHO Definition of Health
Complete physical, mental, and social wellness.
Key Indicators of Mental Health
Key Indicators of Mental Health
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Individual Factors (Mental Health)
Individual Factors (Mental Health)
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Interpersonal Factors (Mental Health)
Interpersonal Factors (Mental Health)
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Social/Cultural Factors (Mental Health)
Social/Cultural Factors (Mental Health)
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Mental health as a dynamic state
Mental health as a dynamic state
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Asylum (Historical)
Asylum (Historical)
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Moral Treatment
Moral Treatment
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Dorothea Dix
Dorothea Dix
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Emil Kraepelin's Contribution
Emil Kraepelin's Contribution
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Eugen Bleuler
Eugen Bleuler
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Psychotropic Drugs
Psychotropic Drugs
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Deinstitutionalization
Deinstitutionalization
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Supplemental Security Income (SSI)
Supplemental Security Income (SSI)
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Social Security Disability Income (SSDI)
Social Security Disability Income (SSDI)
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Revolving Door Effect
Revolving Door Effect
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Community Mental Health Centers Act
Community Mental Health Centers Act
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Chlorpromazine (Thorazine)
Chlorpromazine (Thorazine)
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Lithium
Lithium
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Community Mental Health Movement
Community Mental Health Movement
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Sigmund Freud's Impact
Sigmund Freud's Impact
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Continuous Flow Overwhelm
Continuous Flow Overwhelm
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Boarding (Psychiatric)
Boarding (Psychiatric)
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Revolving Door Phenomenon
Revolving Door Phenomenon
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Dual Problem
Dual Problem
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Homelessness
Homelessness
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Vicious Cycle (Homelessness & Mental Illness)
Vicious Cycle (Homelessness & Mental Illness)
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Inadequate Community Resources
Inadequate Community Resources
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Effective Community Mental Health Services
Effective Community Mental Health Services
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Healthy People 2020 Objectives
Healthy People 2020 Objectives
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Psychosocial Rehabilitation Services
Psychosocial Rehabilitation Services
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Untreated Mental Illness
Untreated Mental Illness
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Integrated Treatment for Co-Occurring Disorders
Integrated Treatment for Co-Occurring Disorders
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Mental Health Screening
Mental Health Screening
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Unmet Mental Health needs
Unmet Mental Health needs
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Mental Illness
Mental Illness
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Factors Contributing to Mental Illness
Factors Contributing to Mental Illness
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Individual Factors (Mental Illness)
Individual Factors (Mental Illness)
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Interpersonal Factors (Mental Illness)
Interpersonal Factors (Mental Illness)
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Social/Cultural Factors (Mental Illness)
Social/Cultural Factors (Mental Illness)
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Purposes of DSM-5
Purposes of DSM-5
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Factors Identified by DSM-5
Factors Identified by DSM-5
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Ancient Views of Mental Illness
Ancient Views of Mental Illness
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Aristotle's Humoral Theory
Aristotle's Humoral Theory
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Humoral Theory Treatment
Humoral Theory Treatment
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Early Christian Views of Mental Illness
Early Christian Views of Mental Illness
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Treatment in Early Christian Times
Treatment in Early Christian Times
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Renaissance Treatment of Mentally ill
Renaissance Treatment of Mentally ill
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Hospital of St. Mary of Bethlehem
Hospital of St. Mary of Bethlehem
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Mental Illness in Early American Colonies
Mental Illness in Early American Colonies
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Nontreatment Consequences
Nontreatment Consequences
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Community Support Services
Community Support Services
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Managed Care
Managed Care
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Utilization Review Firms
Utilization Review Firms
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Case Management
Case Management
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Cost Containment Strategies
Cost Containment Strategies
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Medicare
Medicare
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Medicaid
Medicaid
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SSI
SSI
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SSDI
SSDI
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Future Challenges in Mental Healthcare
Future Challenges in Mental Healthcare
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Impact of Hallucinations on Learning
Impact of Hallucinations on Learning
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Negative Effects of Institutionalization
Negative Effects of Institutionalization
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Disparity in Insurance Coverage
Disparity in Insurance Coverage
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Management of Mental Health Care
Management of Mental Health Care
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Client Boundary Violations
Client Boundary Violations
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Inappropriate Client Behavior
Inappropriate Client Behavior
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Client Violence Risk
Client Violence Risk
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Physical Restraint Protocol
Physical Restraint Protocol
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Encountering Known Clients
Encountering Known Clients
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Client Confidentiality
Client Confidentiality
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Reassuring a Known Client
Reassuring a Known Client
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Shared Problems with Clients
Shared Problems with Clients
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Alameda Model
Alameda Model
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Emergency Psychiatric Care
Emergency Psychiatric Care
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Psychiatric Nurse's Concerns
Psychiatric Nurse's Concerns
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Thinking & Communication Issues
Thinking & Communication Issues
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Danger Assessment
Danger Assessment
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Stress from Life Events
Stress from Life Events
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Medication Management
Medication Management
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Substance Abuse Impact
Substance Abuse Impact
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Self-Perception Issues
Self-Perception Issues
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Basic-Level Nursing Interventions
Basic-Level Nursing Interventions
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Milieu Therapy
Milieu Therapy
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Psychobiologic Interventions
Psychobiologic Interventions
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Advanced-Level Nursing Functions
Advanced-Level Nursing Functions
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Key Elements of Interaction
Key Elements of Interaction
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Therapeutic Relationship
Therapeutic Relationship
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Importance of Listening
Importance of Listening
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Asking Personal Questions
Asking Personal Questions
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Mental Health Parity
Mental Health Parity
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Mental Health Parity Act (1996)
Mental Health Parity Act (1996)
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Culturally Competent Care
Culturally Competent Care
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Linda Richards
Linda Richards
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McLean Hospital
McLean Hospital
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Somatic Therapies
Somatic Therapies
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Nursing Mental Diseases
Nursing Mental Diseases
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Johns Hopkins
Johns Hopkins
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National League for Nursing
National League for Nursing
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Hildegard Peplau
Hildegard Peplau
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June Mellow
June Mellow
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Standards of Care
Standards of Care
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American Psychiatric Nurses Association (APNA)
American Psychiatric Nurses Association (APNA)
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Phenomena of Concern
Phenomena of Concern
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Study Notes
Mental Health and Mental Illness
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Mental health and mental illness are challenging to define, influenced by societal values and beliefs.
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Mental health is a state of well-being where individuals fulfill responsibilities, function effectively, and have satisfying relationships.
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Key indicators of mental health include satisfying relationships, effective coping, a positive self-concept, and emotional stability.
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Factors influencing mental health are individual, interpersonal, and social/cultural, interacting in a dynamic state.
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Individual factors include biologic makeup, autonomy, self-esteem, resilience, and coping abilities.
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Interpersonal factors involve effective communication, the ability to help others, intimacy, and balanced relationships.
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Social/cultural factors encompass community sense, access to resources, intolerance of violence, support for diversity, environmental mastery, and a realistic worldview.
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Mental illness includes mood, behavior, and thinking disorders like depression, schizophrenia, anxiety, and addiction.
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Characteristics of Mental illness: significant distress, impaired functioning, dissatisfaction, and feelings of hopelessness.
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Factors contributing to mental illness are categorized as individual, interpersonal, and social/cultural.
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Individual factors include biologic makeup, unrealistic worries, inability to distinguish reality, intolerance of uncertainty, disharmony, and loss of meaning.
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Interpersonal factors include ineffective communication, dependency or withdrawal, lack of belonging, inadequate social support, and loss of emotional control.
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Social/cultural factors include lack of resources, violence, homelessness, poverty, negative worldview, and discrimination.
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An ongoing debate exists among healthcare professionals regarding whether certain behaviors are illness or simply bad behavior.
Diagnostic and Statistical Manual of Mental Disorders
- The American Psychiatric Association's DSM-5 is a regularly revised taxonomy describing mental disorders and diagnostic criteria.
- The DSM-5 serves to standardize nomenclature, differentiate diagnoses, and assist in identifying underlying causes.
- It identifies psychiatric disorders, relevant medical conditions, and psychosocial/environmental problems affecting diagnosis and treatment.
- Student nurses can use the DSM-5 to understand reasons for admission and learn about psychiatric illnesses.
Historical Perspectives of the Treatment of Mental Illness
- Ancient people thought that illnesses were punishments from the gods, and those with disorders were either divine or demonic.
- Aristotle theorized that mental disorders related to imbalances in body fluids (blood, water, and yellow and black bile).
- Treatment involved restoring balance through bloodletting, starving, and purging.
- In early Christian times, mental illness was blamed on demons, leading to exorcisms and brutal measures.
- During the Renaissance in England, the mentally ill were separated from criminals; harmless individuals could roam freely, while dangerous ones were imprisoned.
- The Hospital of St. Mary of Bethlehem, the first hospital for the "insane", charged visitors fees to ridicule inmates.
- In the early U.S. colonies, the mentally ill who were considered evil were punished, and witch hunts were conducted.
- Philippe Pinel and William Tuke introduced the concept of asylum as a safe haven, which initiated the moral treatment of people with mental illnesses.
- Dorothea Dix advocated for adequate shelter, food, and clothing, and she was instrumental in opening 32 state hospitals.
- State hospitals faced issues like abuse, isolation, and negative connotations.
- Sigmund Freud, Emil Kraepelin, and Eugen Bleuler began the scientific study and treatment of mental disorders.
- Kraepelin classified disorders by symptoms; Bleuler coined "schizophrenia".
Development of Psychopharmacology
- Psychotropic drugs emerged in the 1950s with chlorpromazine and lithium.
- Antidepressants and anti-anxiety agents soon followed.
- These drugs reduced agitation, psychosis, and depression, leading to shorter hospital stays and decreased violence in hospitals.
Move toward Community Mental Health
- The Community Mental Health Centers Construction Act of 1963 supported treating the mentally ill in less restrictive environments.
- Deinstitutionalization shifted care from state hospitals to community facilities.
- Community mental health centers offered emergency, inpatient, outpatient, and partial hospitalization services.
- Federal legislation provided income for disabled people through SSI and SSDI.
- Commitment laws became more stringent, further decreasing state hospital populations.
Mental Illness in the 21st Century
- In the U.S., 44.7 million people have a mental illness, but only 19.2 million receive treatment.
- The 18 to 25 age group has the highest prevalence and lowest treatment rate.
- Mental illness impairs daily activities for 15 million adults and 4 million children and adolescents.
- Mental disorders are the leading cause of disability in the United States and Canada for persons 15 to 44 years of age.
- Only one in four adults and one in five children/adolescents get needed mental health services.
- Deinstitutionalization reduced public hospital beds by 80%, but admissions increased by 90%, creating a "revolving door effect".
- Frequent readmissions overwhelm hospital psychiatric units.
- Emergency department visits for acutely disturbed people have increased significantly.
- Boarding patients in the ED leads to frustration, dissatisfaction, and increased suicide rates.
- Adequate psychiatric inpatient beds may decrease homelessness, incarceration, and violence.
Other Considerations:
- Shorter hospital stays complicate frequent readmissions due to lack of stabilization, resulting in decompensation.
- Dual diagnosis of mental illness and substance abuse exacerbates symptoms and increases rehospitalization.
- Homelessness affects 610,000 people, including 140,000 children; 33% have severe mental illness or substance use disorder.
- Many homeless mentally ill individuals lack adequate community resources.
- Inpatient psychiatric treatment receives the bulk of mental health spending.
- Community mental health services must be individualized, available, and culturally relevant.
Objectives for The Future:
- Healthy People 2020 aims to increase identification, diagnosis, treatment, and improve the lives of people with mental illness.
- The program strives to decrease suicide and homelessness rates while increasing employment and services for incarcerated individuals.
- Community support service programs focus on rehabilitation, vocational needs, education, socialization, symptom management, and medication.
- Service availability and quality vary depending on funding.
- Community-based system flaws, lack of independent living skills, the nature of mental illnesses, and difficulty teaching skills.
- Community-based programs enable clients to stay connected with families and maintain personal freedom.
Cost Containment and Managed Care
- Managed care balances the quality and cost of care, where care is based on need.
- Utilization review firms require providers to seek approval before delivering care to control costs.
- Case management coordinates care to decrease fragmented services and reduce expenses.
- Psychiatric care is costly and primarily relies on subjective reporting.
- Mental health is often separated from physical health in insurance coverage, with specific limits.
- Mental health care is managed through private behavioral health firms.
- The Health Care Finance Administration manages Medicare and Medicaid.
- Medicaid covers low-income individuals and families.
- Mental health parity ensures equality in insurance coverage for physical and mental illnesses.
- The Mental Health Parity Act of 1996 eliminated annual and lifetime dollar limits for mental health care in companies with over 50 employees.
Cultural Considerations
- The U.S. population is increasingly diverse, with growing African, Asian, Arab, and Hispanic communities.
- Nurses must be aware of cultural differences affecting mental health and treatment.
- Family structures are changing, with single-parent and blended families becoming more common.
Psychiatric Nursing Practice
- Linda Richards, the first American psychiatric nurse, advocated for improved care in psychiatric hospitals.
- The first nurse training program for mental illness care was in 1882 at McLean Hospital.
- Early care focused on nutrition, hygiene, and activity, adapting medical–surgical principles.
- Harriet Bailey published the first psychiatric nursing textbook in 1920.
- Hildegard Peplau and June Mellow shaped psychiatric nursing practice.
- Peplau emphasized the phases and tasks of the therapeutic nurse–client relationship.
- Mellow focused on clients’ psychosocial needs and strengths in daily activities.
- The American Nurses Association (ANA) develops standards of care.
- The American Psychiatric Nurses Association (APNA) has standards of practice and professional performance.
- Phenomena of concern include the promotion of health, impaired functioning, alterations in thinking, potential danger, and emotional stress.
Nursing Roles and Responsibilities:
- Basic-level functions include counseling, interventions, problem-solving, crisis intervention, stress management, behavior modification, and milieu therapy.
- Advanced-level functions include psychotherapy, prescriptive authority, consultation, evaluation, program development, and clinical supervision.
- Student nurses have normal concerns, like saying the wrong thing, feeling ineffective, fear of rejection, prying, managing bizarre behavior, facing inappropriate advances, safety, encountering acquaintances, or sharing similar problems with clients.
Best Practice:
- The Alameda Model addresses boarding psychiatric patients in general EDs by transferring them to designated psychiatric emergency facilities.
- In the Alameda Model, ED boarding times were reduced by 80%.
- In the Alameda Model, only 22% of patients required hospitalization after transfer.
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